Why Systemic Therapy Makes Sense in Indian Context

Imagine a 16-year-old girl named Ananya (imagined persona), who is showing symptoms of depression. She is distant from her friends, constantly argues with her parents, and spends a lot of time locked away in her bedroom. Her parents are frustrated. They do not know why she is behaving so differently. They’ve given her everything she needs, after all, a good education, a comfortable lifestyle, and a nurturing family. After a few days, they decide to take her to a therapist.

If Ananya were living within a Western society, her therapist would likely speak to her on an individual level. The discussion would be about her feelings, thoughts, and what actually happened within her life to cause her depression. Most of the therapy would be individual, with Ananya sitting in a room by herself with her therapist. The objective would be for her to realize what she is feeling and how she could deal with her feelings.

Let's consider the same scenario playing out in India. Ananya's depression is not an individual issue, her entire household is suffering. Her parents are concerned, her younger brother is confused, and even her extended family has begun commenting on her change of behavior. A more culturally sensitive approach would include all members of her family. Rather than concentrating exclusively on Ananya, the therapist would talk with her family members about what goes on among them, what role family expectation plays, what pressures she perceives from her family, and how all of them affect each other's behavior.

This is where systemic therapy comes into play.

The Difference: Individual vs. Systemic Approach

The individualistic approach to therapy is centered on the person, looking at their symptoms in the overall context. It leans towards examining what is bothering them and how they could become better. For instance, if only individual therapy were applied to Ananya, what would be examined is her symptoms of depression - why she is sad, why she does not wish to interact with people, and what would be responsible for such feelings.

And, on the flip side, systemic therapy considers the bigger picture. Systemic therapy sees that perhaps Ananya's depression is not only about her and more about the system she is interacting with, which includes her family, friends, and important others in her life. Systemic therapy looks at patterns of communication and behavior.

Systemic therapy asks, “What's going on in the system that's potentially creating her distress and how her distress is affecting others?”

For example, Ananya could be experiencing overwhelming pressure from parents with high expectations for her grades. Her parents could be frustrated because they perceive that they’ve provided her with all she could require. Ananya may also be experiencing pressure from her school and peers, who expect her to person at her best. This misunderstanding and implicit expectations could be driving her feelings of isolation and unhappiness.

In India, community is an important aspect of an individual’s life. Living in a joint family is common where there are multiple generations staying together under the same roof or at least being actively engaged with each other’s lives. The societal focus on the collective over the individual makes systemic therapy specifically relevant. Rather than working with an individual by oneself, systemic therapy knows that what makes an individual mentally healthier influences the entire family.

Note: Family Therapy is NOT Systemic Therapy

Just so we are clear, systemic therapy and family therapy are not the same, though they are closely related.

Systemic therapy is a broader therapeutic approach that focuses on understanding and changing patterns of behaviour and interaction within any system. A “system” can be a family, workplace, social group or any network of relationships.

Family therapy focuses solely on family relationships and dynamics. It addresses the issues within a family unit, aiming to improve communication. In that regard, we may say that family therapy is a type of systemic therapy.

Why Systemic Therapy is Effective in India

Community-Centered Approach: The Indian community remains traditionally focused, with priority on the overall well-being of the family. In such a case, treating mental health issues separately is less effective. Systemic therapy recognizes that family, society, and community all contribute significantly toward influencing a person’s mental wellbeing, making it a more comprehensive and appropriate method.

Cultural Sensitivity: Systemic therapy does not impose Western ideals upon Indian families. Rather, systemic therapy adjusts according to existing cultural values within the family system. Systemic therapy is indeed sensitive to the fact that in Indian homes, emotional expression is often different from generation to generation. Older generations may find it hard to comprehend the emotional needs of younger generations. Systemic therapy provides a space for people with differing points of view so that their viewpoints are validated, and barriers to communication are removed.

Addressing Intergenerational Problems: Most mental health concerns in India are the result of unresolved family dynamics that are carried over into future generations. Systemic therapy is aware of such intergenerational patterns and helps modify them. For instance, if a family has a history of unresolved trauma or communication issues, systemic therapy helps to break such patterns and facilitate healing over generations.

Challenges faced by Systemic Therapy in India

Although systemic therapy has a wealth of benefits, it certainly also has some challenges in India.

Stigma: Mental health care is still stigmatized in India, especially in rural India. Many people consider attending therapy a sign of weakness, or something "only for the wealthy." In such a culture, it would be challenging to get families engaged with a therapist.

Access to Therapy: Systemic therapy needs professionally qualified therapists who are capable of handling complicated family dynamics. In India, mental health professionals, particularly those with training in systemic therapy, are scarce. Therapy is also confined to big cities, which makes it inaccessible for a large number of families living in rural areas.

Lack of Awareness: Even with increasing awareness of mental illnesses, individuals are still unaware of systemic therapy. They tend to stick with individual therapy or even consider family involvement a nonessential or overly complicated process.

Directions for Action

As more counselors receive training for systemic methods and cultural sensitivity develops, systemic therapy would become a staple for a healthier mental life throughout the country. Going forward, blending systemic therapy with conventional and community-based support mechanisms could hold the answer for addressing mental health issues in India, making it a process of transformation for families and not merely a therapy for individuals.